Effects of Hypertension, Diabetes Mellitus, and Gender on Post Stroke Cognitive Impairment: Meta-Analysis
DOI:
https://doi.org/10.26911/jepublichealth.2024.09.01.07Abstract
Background: Post-stroke cognitive impairment is a serious problem that is often faced by indivi-duals who have experienced a stroke. This study aims to determine and estimate the effects of hypertension, diabetes mellitus, and gender on post-stroke cognitive impairment through meta-analysis of primary research conducted by previous researchers.
Subjects and Method: This was a meta-analysis study using the PICO model which includes; P: post-stroke patients. I: hypertension, diabetes mellitus, and women. C: normotensive, without diabetes mellitus, and men. O: post-stroke cognitive impairment. A systematic search for primary studies was carried out in the PubMed database which was published from 2014 to 2023. The keywords used to search for primary studies were "Hypertension" AND "Diabetes Mellitus" AND "Post Stroke Cognitive Impairment". The inclusion criteria for the articles searched were primary studies with cross-sectional and cohort studies from 2014-2023 and reporting aOR values. Primary studies were selected using the PRISMA diagram and relevant primary studies were analyzed using Review Manager 5.3.
Results: There were 18 primary studies with cross-sectional and cohort study designs. The total sample obtained through a systematic review and meta-analysis was 9,103 post-stroke patients from France, China, Singapore, the Netherlands, Egypt, Ethiopia, and Uganda. The results of the analysis showed that hypertension increased the risk 1.56 times (aOR= 1.56; 95% CI= 1.11 to 2.19; p= 0.010) and diabetes mellitus increased the risk 1.58 times (aOR= 1.58; 95% CI= 1.23 to 2.05; p< 0.001) post-stroke cognitive impairment compared to people without hypertension and diabetes. Meanwhile, the female gender increases the risk of post-stroke cognitive impairment by 1.28 times (aOR= 1.28; 95% CI=1.16 to 1.42; p<0.001). The data is statistically significant.
Conclusion: hypertension, diabetes mellitus, and female gender increase the risk of post-stroke cognitive impairment.
Keywords: Hypertension, diabetes mellitus, women, post-stroke cognitive disorders
References
Ayehu GW, Admasu FT, Yitbarek GY, Teshome AA, Amare AT, Atlaw Daniel, Sharma S. (2023). Early post-stroke cognitive impairment and in-hospital predicting factors among stroke survivors in Ethiopia. FRONT NEUROL. 14(5): 1–9. doi: 10.3389/fneur.2023.1163812.
Chander RJ, Lim L, Handa S, Hiu S, Choong A, Lin X, Singh R, et al. (2017). Atrial Fibrillation is Independently Associated with Cognitive Impairment after Ischemic Stroke. J. Alzheimer's D. 60(3): 867–875. doi: 10.3233/JAD-170313.
Cherkos K, Jember G, Mihret T, Fentanew M. (2023). Prevalence and Associated Factors of Cognitive Impairment Among Stroke Survivors at Comprehensive Specialized Hospitals in Northwest Ethiopia: Multi-Centered Cross-Sectional Study. Vasc Health Risk Manag. 19(4): 265–277. doi: 10.2147/VHRM.S405357.
Ding MY, Xu Y, Wang YZ, Li PX, Mao YT, Yu JT, Cui M, et al. (2019). Predictors of Cognitive Impairment after Stroke: A Prospective Stroke Cohort Study. J. Alzheimer's D. 71(4): 1139–1151. doi: 10.3233/JAD-190382.
Esmael A, Elsherief M, Eltoukhy K. (2021). Prevalence of cognitive impairment in acute ischaemic stroke and use of Alberta Stroke Programme Early CT Score (ASPECTS) for early prediction of post-stroke cognitive impairment. Neurol Neurochir Pol. 55(2): 179–185. doi: 10.5603/PJNNS.A2021.0006.
Nyenhuis DL, Gorelick PB. (1998). Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment. J Am Geriatr Soc. 46(11): 1437-48. doi: 10.1111/j.1532-5-415.1998.tb06015.x. PMID: 9809769.
Jacquin A, Binquet C, Rouaud O, Graule-Petot A, Daubail B, Osseby GV, Bonithon-Kopp C, et al. (2014). Post-stroke cognitive impairment:High prevalence and determining factors in a cohort of mild stroke. J. Alzheimer's D. 40(4): 1029–1038. doi: 10.3233/JAD-131580.
Jiao Y, Tian T, Wei S, Wang C, Wu L . (2020). Association between serum non-high-density lipoprotein cholesterol and cognitive dysfunction after acute ischemic stroke: A cross-sectional study. Braz J Med Biol. 53(12): 1–9. doi: 10.1590/1414-431x2-0209487.
Kaddumukasa MN, Kadduumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. (2023). Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda. BMC Neurol. 23(1): 1–8. doi: 10.1186/s12883-023-03212-8.
Kalaria RN, Akinyemi R, Ihara M. (2016). Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta. 1862(5):915-25. doi: 10.1016/j.bbadis.2016.01.015
Li P, Quan W, Lu D, Wang Y, Zhang HH, Liu S, Jiang RC, et al. (2016). Association between metabolic syndrome and cognitive impairment after acute ischemic stroke: A cross-sectional study in a Chinese population. PLoS ONE. 11(12): 1–13. doi: 10.1371/journal.pone.0167327.
Li X, Li Y, Zhao S, Chen X, Wang L, Xhang X. (2023). Early cognitive dysfunction after stroke and related risk factors in the high-altitude and multi-ethnic region of Qinghai, China: A multi-center cross-sectional study. Clin Neurol Neurosurg. 225(12): 107607. doi: 10.1016/j.clineuro.2023.107607.
Lin Y, Guo S, Liu X, Huang D. (2020). Metabolic syndrome is associated with cognitive impairment after transient ischemic attack/mild stroke, but does not affect cognitive recovery in short term. NeuroReport. 31(12): 918–922. doi:10.1097/WNR.0000000000001500.
Monica W, Widyaningsih V, Sulaeman ES (2019). Meta-analysis on The Effects of Hypertension, Type II Diabetes Mellitus, and Smoking on the Risk of Stroke among Asian Young Adult Population. J Epidemiol Public Health. 4(4): 296–306. doi: 10.26911/jepublichealth.2019.04.04.04.
Nijsse B, Visser-Meily JM, van Mierlo ML, Post MW, de Kort PL, van Heugten CM. (2017). Temporal evolution of poststroke cognitive impairment using the montreal cognitive assessment. Stroke. 48(1): 98–104. doi: 10.1161/STROKEAHA.116.014168.
Nopia D, Huzaifah Z (2020). Hubungan antara klasifikasi stroke dengan gangguan fungsi kognitif pada pasien stroke. JNI. 1(6): 16-22. doi: 10.33859/jni.v1i1.11.
Pramudita A, Pudjonarko D (2016). Faktor-Faktor Yang Mempengaruhi Fungsi Kognitif Penderita Stroke Non Hemo-ragik. JKedokteran Diponegoro. 5(4): 460–474.
Pratiwi DI, Tamtomo D, Murti B (2019). Is Cognitive Impairment a Risk Factor for Post-Stroke Depression? A Meta-Analysis Study. J Epidemiol Public Health. 4(2): 81–87. doi: 10.26911/jepublichealth.2019.04.02.03.
Pudiastuti RD (2011). Penyakit Pemicu Stroke Edisi 1. Yogyakarta: Nuha Medika
Qu Y, Zhuo L, Li N, Hu Y, Chen W, Zhou Y, Wang J. et al. (2015). Prevalence of poststroke cognitive impairment in china a community-based, cross-sectional study. PLoS ONE. 10(4): 1–13. doi: 10.1371/journal.pone.0122864.
Saedi E, Gheini MR, Faiz F, Arami MA. (2016). Diabetes mellitus and cognitive impairments. World J Diabetes. 7(17): 412-22. doi: 10.4239/wjd.v7.i17.412.
Swardfager W, MacIntosh BJ. (2017). Depression, Type 2 Diabetes, and Poststroke Cognitive Impairment. Neurorehabil Neural Repair. 31(1): 48–55. doi: 10.1177/1545968316656054.
Tumiwa F, Pinzon RT, Sugianto. (2017). Hubungan hipertensi dengan gangguan fungsi kognitif pada pasien post-stroke iskemik di RS Bethesda (The relationship between hypertension and impaired cognitive function in ischemic post-stroke patients at Bethesda Hospital). J Kedokteran YARSI. 25(3): 135-144. doi: 10.33476/jky.v25i3.368.
Tzourio C. (2007). Hypertension, cognitive decline, and dementia: an epidemiological perspective. Dialogues Clin Neurosci. 9(1):61-70. doi: 10.31887/DCNS.2007.9.1/ctzourio.
Xu L, Xiong Q, Du Y, Huang L, Yu M.(2023). Nonlinear relationship between glycated hemoglobin and cognitive impairment after acute mild ischemic stroke. BMC Neurology. 23(1): 1–10. doi: 10.1186/s12883-023-03158-x.
Yan X, Chen H, Shang XL. (2022). Association between serum cystatin C level and post-stroke cognitive impairment in patients with acute mild ischemic stroke. Brain Behav. 12(3): 1–8. doi: 10.1002/brb3.2519.
Zamzam M, Tamtomo DG, Widyaningsih V. (2020). Biopsychosocial factors affecting quality of life in post-stroke patients: A path analysis evidence from Surakarta Hospital, Central Java. J Epidemiol Public Health. 5(1): 1–14. doi: 10.26911/jepublichealth.2020.05.01.01
Zewde Y, Alem A, Seeger SK. (2023). Magnitude and predictors of post-stroke cognitive impairment among Ethio-pian stroke survivors : a facility-based cross-sectional study. BMC Neurol. pp. 1–17.doi:10.21203/rs.3.rs2852302/v1.
Zuo L, Dong Y, Liao X, Pan Y, Xiang X, Meng X, Li H. et al. (2022). Risk factors for decline in Montreal Cognitive Assessment (MoCA) scores in patients with acute transient ischemic attack and minor stroke. J Clin Hypertens. 24(7): 851–857. Doi: 10.1111/jch.14453.
